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Purpose: To assess the prognostic value of T category of the 8thedition of American Joint Committee on Cancer (AJCC) classification in periocular sebaceous gland carcinoma (SGC). Methods: Retrospective interventional case series of 119 cases. Results: Based on the T category of 8th edition of AJCC classification, 119 periocular SGCs were classified into T1 (n= 33, 28%), T2 (n= 37, 31%) T3 (n= 17, 14%) and T4 (n= 32, 27%). There were no statistically significant differences in the rate of tumour recurrence based on T category. The outcome measures that showed significant increase with increase in T category included regional lymph node metastasis (3% for T1, 3% for T2, 12% for T3, and 44% for T4; p< 0.0001), systemic metastasis (0% for T1, 0% for T2, 12% for T3, and 25% for T4; p= 0.002) and death due to metastasis (0% for T1, 0% for T2, 12% for T3, and 22% for T4; p= 0.005). The 5-year Kaplan-Meier estimate rate for regional lymph node metastasis, systemic metastasis and metastasis-related death were all higher for the T4 category tumours (42%, p= 0.005; 34%, p= 0.0002; and 43%, p= 0.0001 respectively) compared to T1 (9%, 0%, and 0%), T2 (5%, 0%, and 0%) and T3 (10%, 17 and 8%) tumours. Conclusion: Primary tumour (T) category of the 8thedition AJCC classification predicts the prognosis of patients with periocular SGC. The rates of lymph node metastasis, systemic metastasis, and death is much higher in T4 tumours compared to T1, T2, and T3 tumours. There was no association between T category and tumour recurrence.

Purpose: To compare the clinical features, histopathology features, treatment, and prognosis of patients with and without pagetoid tumour spread secondary to periocular sebaceous gland carcinoma (SGC). Methods: Retrospective study of 130 patients with SGC who underwent conjunctival map biopsy. Results: Of the 130 patients with SGC, 30 (23%) patients had histopathology proven pagetoid tumour spread. On multivariate analysis, increasing tumour basal diameter (p< 0.001) was predictive of pagetoid tumour spread. The odds ratio for tumour basal diameter in prediction of map biopsy positivity for pagetoid tumour spread was 1.13 (95% CI, 1.07–1.19). The sensitivity and specificity of clinicopathological correlation of pagetoid tumour spread was 57 and 90%. Overall, globe salvage was better in those without pagetoid tumour spread compared to those with pagetoid tumour spread (95% vs 33%; p< 0.0001). Comparing those with pagetoid tumour spread vs those without, the 5-year Kaplan–Meier estimate of systemic metastasis was 21% vs 4% (p= 0.15) and death was 28% vs 4% (p= 0.21), respectively. Conclusion: Increasing tumour basal diameter can predict the risk of pagetoid tumour spread. Every mm increase in tumour basal diameter increases the risk of pagetoid tumour spread by 13%. Map biopsy is recommended for all patients with periocular SGC’s. Though the globe salvage rates are poor in those with pagetoid tumour spread, the occurrence of systemic metastasis and death are not significantly higher compared to those without pagetoid tumour spread.

A good surgical clearance can be obtained by a combined external and endoscopic approach in cases of solitary fibrous tumors of the lacrimal drainage system with orbital and sinonasal extensions.